Sunday, July 16, 2017

Advice for Ohio Physicians: What a Physician Learned by Lobbying in Texas

This important post was penned by my colleague, Judith Thompson, MD, an independent breast surgeon in Texas who also serves as Practicing Physicians of America's (unpaid) Board Chairman:

As I learned to lobby, I went around with groups and watched/listened as individuals presented what they wanted a legislator to know. What I believe I saw was often one very bright group engaged in monologue with another individual or group which may or may not have been listening.

I made it my objective to engage in dialogue when lobbying.

I began by asking the legislator or their assistant, depending upon with whom I was speaking , if they were aware of the bill. If their answer was no then I would begin with an introduction of the bill and what my position was and why. If yes, then I would say what my position was and ask the individual if they had questions. This allowed me to focus on what the individual needed to know. At times I was asked questions for which I didn’t have answers. I made it a point to write that question down, get the answer and deliver it back to the legislator/assistant who had asked. I could see that that made a difference. Their countenance changed and they said “thank you”. Defensive listeners became receptive listeners.

My talking points were simple and clear and it went something like this:

The American healthcare industry is in need of change and that those changes must accomplish at least one, if not all three of the following:

Improved patient access to physicians

Improved safety or quality

Reduced cost

The MOC® product fails in all three.

MOC® is a proprietary product that has no return on investment for physicians. It is an obstacle to healthcare delivery and can obstruct a physician’s right to work. Requirements for MOC® have been woven into physician licensing, hospital credentialing and commercial insurance contracts. As a result, if a physician chooses not to participate in what is falsely advertised as a voluntary program, then they may lose their license, credentials or commercial insurance contracts. This is hardly voluntary.

The MOC® licensing cycle is so onerous and expensive, that mature, experienced physicians are choosing to retire rather than go through the recertification process again thereby worsening the physician shortage and extracting from the physician population some of the most experienced and knowledgeable individuals.

It is not my nature to spend time pointing out the misconduct of others but in this case, we are remiss not to do so. As a result of the actions of the American Board of Internal Medicine (ABIM) and the American Osteopathic Association, both organizations are currently involved in anti-trust, discriminatory and civil-rights lawsuits. Please refer Wes’s MAINTENANCE OF CERTIFICATION® (MOC®) FACT SHEET.

All of the sub specialty organizations require doctors to spend precious time entering data, under the guise of “quality metrics” in order to maintain board certification. What is done with data? Either sell it for a profit or use it for population management. To this, we must object and abstain, albeit at the risk of losing our ability to practice our profession.

What Ohio’s HB 273 will do:

Improve availability of physicians and patients access to care. Especially in rural and underserved areas

Prevents hospitals from requiring physicians to secure MOC as a condition of employment or having admitting privileges.

Prevents third parties from requiring MOC® as a condition of contracting or payment.

Prevents the “board” from requiring MOC® as a condition of being issued a certificate to practice medicine and surgery or osteopathic medicine and surgery.

Prepare to encounter opposition from special interest groups. These groups will spread misinformation and tell legislators that the MOC product is necessary to maintain high professional standards and protect public safety. When the ABMS is asked to produce evidence to support these statements, the evidence is of both poor scientific quality and contains conflicts of interest. With regard to maintaining high professional standards, there is no evidence to support this claim.

I suggest that you have a brief, direct, concise and simple message to deliver with facts without embellishment. My lobbying experience was so gratifying, that I truly believe I made a difference and am sure I’ll do it again.

TO DO LIST FOR OHIO PHYSICIANS

Contact your OSMA executive director and tell them that you want the OSMA to strongly endorse OHB273

Contact your OSMA District Counsellor with the same

Contact your state representatives and senators with the same. Make phone calls and send emails

If you can make time to go to Columbus to lobby, then make plans to do so. It would be very helpful if you can be there to testify on behalf of the bill

I made it a point to meet the each committee member or their representative. You have 20 house members and therefore perhaps should divide the job between a group of physicians although I suggest you have no more than two or three physicians present for each meeting. Again, I did it independently which allowed for personalized conversation

Ohio, it's your turn. Don your flak jackets and take action. Give each legislator this ABMS MOC® Fact Sheet. It will be up to you to inform these Ohio legislators the truth about the corrupt ABMS Maintenance of Certification® program to assure passage of HB 273.

-Wes

Addendum: At this time, it appears this bill will be heard sometime in September. If history is any guide, advance notice of the bill's arguments may be made with little advance warning. Stay tuned.

MOC has always been a big crock and so is the notion that it is somehow connected with "keeping up". ABIM, all-of-the medical boards have done a great deal of mischief and harm to physicians and the healthcare system. And it has harmed me and my family. My doctor just closed his office and retired early. Private, but connected to a hospital. He had paper records and was not participating in MOC and we loved him. Very thorough and had many skills that others today do not. I am still trying to find a new physician. And my brother is only eligible he tells me to see an NP or PA for a primary care doc. He has a very high deductible insurance and it forces him to go to an HMO. It is not fair to not have a real choice. It's not fair to lose you doc to MOC.

The ABMS has actually become a distraction to healthcare. It is the one not keeping up. The ABMS is no longer focused on its primary task of lifetime certification. The medical boards and its umbrella have grabbed at money with both fists. MOC and certification.

They have stabbed their base of clients in the back playing politics. They have turned their backs on their US clients and ventured abroad seeking more profits. They have lost even more focus as a result.

Because of their unfortunate greed for money and grasping for political power, because of their betrayal and adventurism abroad, they are no longer focused, adept or trustworthy to hold on to any task.

Let the volunteer physicians and academicians with the skill and knowledge continue to write test questions and put together certification tests. But get rid of the mischief makers doing the harm--the executives who are robbing us blind.

Let the ABMS specialty boards be a totally volunteer organizations again, as they were in the beginning.

Restore lifetime certification. Get the money and politics out and keep it out.

Anti-MOC legislation is a must in every state and territory. Medicine will fail to perform as needed and patients will suffer as the labor force is pushed to the brink of stress, exhaustion and frustration.

Early retirement/candidates not wanting to go into medicine are the result as those under such useless, burdensome and unnecessary mandates like MOC. Many certified docs just leave clinical medicine to do something else. The numbers of practicing clinical physicians in the US does not tell us how many clinicians actually see patients and for how many days per week.

If you look at the ABMS website where they tell you how many physicians are certified, they don't tell you that many of them are retired, left practice, have no license to practice, or how many of those are even dead. They don't bother to keep up with accurate data and one is not sure why.

The 860,000 certified physicians they boast about as being is a verifiable lie. For example one of the key executives at the ACGME is listed as certified with the ABIM, but has not had an active license to practice medicine in years. How can that be considered a certified physician keeping up.

Look at the graduation dates of some of their diplomates. Graduated in what year? Some names finished school before the ABIM was even in existence! This just another blatant example of the kind of misstatements, continuous abuse of clients and patients and actual kinds of phony display of public fraud, which the ABMS has come to represent.

They say that out of those "860K", 520,000 docs are participating in MOC. I highly doubt that "520K" figure as well. If you peruse the huge physician lists in gastroenterology at John Hopkins, which take a very long time to scroll and click through, I could not find more than a couple that were participating in MOC. That includes the wife of the CEO and the CEO who does not participate in MOC.

Scroll through the ABIM's website under the last name Jones or Smith or Patel and you will see that the majority are not participating in MOC. So to say that out of 860K docs that 520K docs are doing MOC is a statistical improbability. Even my mother's physician who is a new certifying internist, they are listed as not participating in MOC.

What is going on here? I'd like to know. We are going to have a huge crisis ahead if these physicians lose their certification status, because they refuse to do MOC. The numbers are more than the ABMS and ABIM are telling us.

Restricted access to physicians will become the new normal unless the ABMS MOC is reined in.

You know, Wes, unless my state passes anti-MOC (anti-discrimination) legislation, this year or next, I'm out. I don't think I am going to make it as a physician in private practice.

ABIM and the others are so corrupt and out of touch, I don't want my name associated with them. I refuse to play their slot machine high stakes casino testing game. MOC is stupid and a manipulative Ponzi scheme eating me and my practice alive.

MACRA is another imbecilic joke on everyone that is eating me, my money and time. It is just another pay downgrade in the pipeline to force doctors out of private practice and into the arms of corporate medicine. It creates conditions for me to see fewer patients and I am burning out.

Strange, but I can go and work at Google for more money, after I pay all my expenses; and those salaries in tech keep going through the roof.

Who wants to be associated with a monopolistic propagandist corporation that takes the joy out of everything? MOC has to end one way or another soon, or I'll start my own tech or BtoB business. I still love medicine, but I can't stay in business with MOC and everything else being thrown at me.

Really, thanks for everything you and others are doing. We'll try and donate some money to the PPA soon. I know it is like salt in water, you have to get to a saturation point with money before you can do anything major. We all need to contribute, whether we stay or go. We are all patients too. Patients should contribute in order to be worth their salt too. Everything we do will help make us all whole again.

State legislation is a must or the medical system is doomed. Patients are doomed. All because of stubbornness and greed. The ABMS is not honest. They are not telling us the truth of what is coming down the pike. Just like the tobacco companies they supported for years did not tell us the truth about tobacco consumption and cancer and cardio vascular disease.

If the MOC status quo continues as it is giving ABMS executives the big paydays, golden parachutes, and grooming them for high political rank it makes for a volatile admixture. With virtually unlimited free time to lobby for their corporate cronies and against physicians and patients (like Kevin Weiss and Christine Cassel did) we are in very deep trouble.

The hearing for HB 273 is going to be on Wednesday, 10/11; it's on the Agenda posted on the Health Committee website. I need to be clear on something -- do I email/call my district house representative and/or senator and/or any specific person on the health committee, or just all of them? Do state senators get to vote on house bills? I also will print out the informational sheet and leave it in the doctor's dining lounge. I suggest we all do this, so many docs call on Monday and Tuesday.

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About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.